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House unanimously passes prior authorization reform for health insurers with delayed implementation
Summary
Senate Bill 22-80 standardizes prior authorization timelines and requires clinical reviewers; the House passed the bill 93–0 and delayed effective date to Jan. 1, 2026 to allow implementation.
The North Dakota House voted unanimously on April 8 to pass Senate Bill 22-80, a measure that sets statutory standards for health insurance prior authorization. The final vote was 93–0.
Representative Volmert presented the bill as the consensus product of patient advocates, providers and insurers. "The bill before you is a product of hours of testimony and negotiation between proponents and opponents of the legislation," Volmert said, summarizing committee work that led to agreed timelines and reviewer qualifications.
Key provisions create statutory timelines for prior authorization decisions (72 hours for urgent cases and 7 days for nonurgent cases), require that prior authorization reviews be conducted by licensed physicians or pharmacists rather than nonmedical staff, and provide for automatic approval if insurers fail to meet the timeframes. The bill also includes a study provision for the Legislative Management to examine impacts on the public employee retirement system and to consider electronic submission of prior authorizations.
Lawmakers and the committee emphasized compromise across stakeholders, and the bill delays implementation until Jan. 1, 2026 to give insurers and pharmacy benefit managers time to adapt systems.
Representative Volmert said the bill "balances the needs of patients, respects medical professionals' expertise and provides responsible guardrails within the prior authorization process." The House approved the bill on a unanimous final vote of 93 yays and 0 nays.
The bill includes compliance timelines, reviewer qualifications, and a study provision; departments and insurers will use the delay to change administrative practices ahead of the 2026 effective date.
